Provider Demographics
NPI:1356339212
Name:JOSEPH, STUART K (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:K
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9299 CORAL REEF DR
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1775
Mailing Address - Country:US
Mailing Address - Phone:305-233-5760
Mailing Address - Fax:305-233-3615
Practice Address - Street 1:9299 CORAL REEF DR
Practice Address - Street 2:
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1775
Practice Address - Country:US
Practice Address - Phone:305-233-5760
Practice Address - Fax:305-233-3615
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54779174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM035576300Medicaid
FLE22504Medicare UPIN
FM035576300Medicaid